Provider Demographics
NPI:1194111310
Name:ARIZONA NATURAL MEDICAL CENTER
Entity type:Organization
Organization Name:ARIZONA NATURAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELYNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-999-4230
Mailing Address - Street 1:821 W WARNER RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2926
Mailing Address - Country:US
Mailing Address - Phone:480-999-4230
Mailing Address - Fax:480-999-4231
Practice Address - Street 1:821 W WARNER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2926
Practice Address - Country:US
Practice Address - Phone:480-999-4230
Practice Address - Fax:480-999-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1324175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1891049912OtherNPPES
AZ1417200627OtherNPPES